Monday, May 31, 2021

Lower Gastrointestinal Bleeding

EmDocs - May 31, 2021 - By Alexander Garrett and Manpreet Singh
Reviewed by: Michael Yoo; Alex Koyfman; Brit Long
“Take Home Points/Pearls/Pitfalls:
  • Stability is key. Most lower GI bleeds will self-resolve and tend to be less severe than upper GI bleeds. Consider UGIB with rapid transit if the patient is unstable and/or has upper GI risk factors (e.g., cirrhosis).
  • CTA is the preferred imaging modality for active lower GI bleeds, with a high sensitivity and specificity for identifying bleeding sources in active If the bleeding has stopped, the sensitivity and specificity is lower.
  • Patients on anticoagulation with active bleeds should pause their anticoagulation. Unstable patients should be reversed, if possible.
  • Always consider aortoenteric fistula in your differential. Ask the patient about their surgical history (specifically regarding abdominal aortic aneurysm repair), as this is a life-threatening diagnosis.”